Outcomes with Endovascular Therapies vs. Medical Treatment for the Treatment of Intracranial Artery Stenosis: A Meta-analysis and Time-to-event Analysis of Randomized Controlled Trials
Mohamed Saad Sayed1, Basma Kamel2, Omnia Samy El-Sayed3, Alaa Abdrabou Abouelmagd4, Mena Ayman Elgendy5, Elsayed S. Moubarak6, Mohammed Osama Abdelmawla7, Omar Abdelkader8, Sai Krishna Vallamchetla9, Marym Taha Mohammed10
1Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt, 2Faculty of Medicine, Mansoura University, Egypt, 3Faculty of Medicine, Zagazig University, Zagazig, Sharkia, Egypt, 4Faculty of Medicine, South Valley University, Qena, Egypt, 5Faculty of Medicine, Misr university for science and technology, 6Faculty of Medicine Cairo University, Cairo, Egypt - Medical Research Group of Egypt (MRGE), Negida Academy, Arlington, MA, USA, 7Faculty of Medicine, Kafrelsheikh University, Kafr El-Sheikh, Egypt, 8Neurology, Westchester Medical Center, 9Neurology, Mayo Clinic, Florida, 10Diagnostic radiologist at Theodor Bilharz Research Institute, Cairo, Egypt.
Objective:
To evaluate the short-term and long-term outcomes of EVT compared to MT in intracranial atherosclerosis.
Background:
There is still controversy about the use of endovascular therapy (EVT) for symptomatic intracranial stenosis (ICAS). Prior studies on percutaneous transluminal angioplasty and stenting have demonstrated either harm or no benefit compared to best medical treatment (MT).
Design/Methods:
We systematically searched four databases: PubMed, Embase, Scopus, and Web of Science (WOS), from inception to April 5, 2025, without applying any automated filters or language restrictions. Randomized controlled trials (RCTs) comparing EVT versus BMT for patients with symptomatic ICAS of 50% or greater were eligible for inclusion in the analysis. Effect estimates were conducted using a random-effects model.
Results:
A total of 10 RCTs comprising 1847 patients, 923 in the EVT group and 924 in the MT group. EVT was associated with higher risk of any stroke or all-cause death (OR: 2.69, 95% CI: [1.71 to 4.21], p<0.0001, I²=0%), any ischemic stroke [OR: 2.11, 95% CI: [1.24 to 3.59], p=0.005, I²=0%], intracranial haemorrhage [OR: 3.69, 95% CI: [1.36 to 10.03], p=0.01, I²=13.0%], and all-cause mortality [OR: 3.54, 95% CI: [1.12 to 11.19], p=0.03, I²=0.0%], however the risk of acute ischemic stroke in the qualifying artery territory was similar between the two groups [OR: 0.88, 95% CI: [0.35 to 2.22], p = 0.78, I²=71.0%] within 30 days. Across the first year, the incidence of intracranial haemorrhage was higher in the EVT vs. MT (OR: 4.76, 95% CI: [1.41 to 16.01], p=0.01, I²=0.0%), however, the rest of outcomes were similar between the two groups.
Conclusions:
Our analysis showed that EVT increased the risk of early adverse effects, without increasing the long-term stroke or mortality events compared to MT. Further studies are needed to underscore the long-term effects.
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